Foot Care For The Elderly-Podogeriatrics
For podiatrists, podogeriatrics – care of the feet of the elderly – is a daily cause for concern, for a variety of reasons. I know that it is a part of our professional work that is often not looked at with much enthusiasm. There are more "old" people around because we are living longer. The foot care required by the older person is usually considered ‘routine.’ There are often financial considerations, due to lack of funds.
However, in a seminal piece of research published by the Disabled Living Foundation (UK) in 1983, is was found that the elderly (people of pensionable age), were occupying 85.9% of the National Health Service (NHS) podiatrists’ clinical time. There have been many changes in NHS policy and the provision of foot care since then and also to the way podiatry is practised in the UK, but one wonders just how we are doing in South Africa.
I would guess that the majority of our elderly people don’t have access to adequate foot care from a podiatrist. This is largely due to the inbalances in the structure of health care in the country, where the majority of the older people only have access to State care not private. Hence the proliferation of other "foot carers" such as nurses, health care assistants,beauty therapists and others, all of whom have responded to specific needs.
Getting older should not be a punishment for living longer and I believe there exists a desperate need for quality foot care for the older person. Podogeriatrics is not and should not be a case of regular cutting a filing of nails plus some callus reduction, carried out in quick time for a small fee.
Today I was visited by a few "oldies". Mary has just retired from a lifetime of teaching and came complaining about her painful left foot, where she was concerned that "there is a small piece of a fixation pin poking out under my foot, because there is a sharp pain in the callus and my surgeon told me after he had removed the pin originally, that there was still a piece that he could not get out".
By carrying out a simple biomechanical examination of Mary’s feet, I was able to analyse the possible source of the problem and treatment included reducing the painful callus and at the point of greatest pressure, enucleating the corn and recommending appropriate non-adhesive padding. In the long-term a simple cushion insole will probably be necessary.
80 year-old Harry also visited me for the first time asking if I could help him with his increasingly painful left foot and salvage his old but comfortable sandals. Again a careful, but simple, assessment of the structure and function of Harry’s feet (Biomechanical assessment), led to me inserting a pair of preformed moulded insoles (orthotics), into his shoes. To further improve function I added a piece of felt at a strategic spot under the insole – an immediate sense of support and noticeable improvement of foot alignment.
The advice for the sandals was to take then to a local African kerbside shoe repairer with instructions to replace the soles appropriately. The lesson here is that podiatric care can be a major benefit to the elderly and that it extends far beyond simple nail cutting. (Although that IS all that is required).
Nevertheless, I don’t want to spend all my days cutting and filing toe nails!! What I do enjoy is seeing results of simple care plans. What we need in South Africa is evidence of the real and perceived need for foot care amongst this age group. Then we can lobby Government for improvements in the provision of podiatry services for the elderly nationwide for all our people.
Sports Podiatry and Football Injuries-an end in sight?
What would podiatrists who treat foot injuries say about a football boot that will encourage players to consider injury protection as much as performance when choosing footwear? I found the following information in the July 2007 issue of the Brighton Graduate, the magazine of the University of Brighton Graduates Association.
The prototype boot, called the RF5, has spawned a new buzzword – ‘safe performance’. Designer Jonathan Farr at the University of Brighton says the aim of creating such a boot was "to provide protection of the foot and lower limbs alongside the feeling, efficiency and range of motion required to achieve maximum performance." According to Jonathan, "footwear in sports serves three major functions.
- provide adequate and effective adhesion between the feet and the playing surface
- protect the feet
- permit normal movement."
He believes that these functions have yet to be perfected in sports footwear as the interaction of the legs, feet, footwear and ground is still to be fully understood.
The design of the RF5was influenced by research into the causes of injury (etiology), measurements of body size and proportions (anthropometrics), and structure and function (biomechanics). In addition user-centred aspects, emotional elements and boot design were included.
The RF5 boasts some impressive features. An outsole that dissipates pressure and reduces unwanted foot movement; a stud pattern that spreads pressure and reduces foot fixation; a heel cup that helps prevent ankle and knee injury and contoured insoles to give arch support, help postural position and joint alignment.
The only illustrations are clearly computer aided design, so it remains to be seen whether the prototype and concept can be developed cost-effectively into production and then scientifically researched to prove that these design features really do prevent injury. Certainly it appears that some of the features have a therapeutic potential.
Unfortunately, RF5 may ultimately only be suitable for players on World Cup 2010 on your XBox! I hope not.
A Word On…. Your Feet
Don’t miss Talk Radio 702 on Tuesday, 7 August at 7pm when I will be joining Prof Harry in this week’s "A Word on..Medical Matters" when we will be talking about feet. How to look after them and what to do when things go wrong with them – as well as answering listeners questions about their specific foot problems.
Check the programming at http://www.702.co.za/onair/lineup.asp
Fascinating Foot Facts
* The average adult takes in excess of 18,000 steps a day. For children it’s even more.
* In a lifetime your feet will walk approximately 112000 kilometres – that’s four time around the earth.
* Leonardo da Vinci called the foot a masterpiece of engineering. each foot has 26 bones, 19 muscles, more than 100 ligaments, thousands of nerve endings and a complex network of blood vessels.
Every time your foot hits the floor when walking it’s the equivalent of twice your body weight. if you are running this increases to three times your body weight.
Fascinating Foot Facts
* The foot has 250,000 sweat glands, they release about 200 mls of perspiration every day.
* Around 70% of foot problems come from wearing the wrong footwear or ill-fitting shoes. Many of these foot problems start in childhood.
* 85% of diabetic foot ulcers are caused by footwear.
* In the United Kingdom, about 30 million pounds is spent annually on foot care services for the elderly.
* Even the Bible records the foot problems of King Asa, David’s son……"nevertheless in the time of his old age he was diseased in his feet." (1 Kings 15:23).